Choline is a specialty nutrient with low consumer awareness. However, due to choline’s critical role in health and wellness, that situation is about to change. FORTIFIED FOODS AND BEVERAGES continue to be a cornerstone of the functional food industry. According to Information Resources Inc., one in five of the US best-selling new foods and drinks in 2013— also claimed to be enriched with vitamins, minerals or other nutrients. Globally, Euromonitor data also show the number of products with fortified claims grew more than 8% during 2013. This slightly edged growth of products with natural/healthy claims (7. 8%), organic (6%) and general “better-for-you” claims such as being “low in fat” (4%). Added essential nutrients have proven to be a strong motivator for the purchase of better-for-you foods. For this reason alone, it’s important for food and beverage marketers to stay on top of new health benefits and market news associated with essential nutrients and adjust their formulations and market claims positioning accordingly. In 1998, the Institute of Medicine (IOM) recognized choline as an essential nutrient needed by humans, and critical for fetal and proper child development. The adequate intake (AI) recommendation for choline is 550mg/ day for men and 425mg/day for women. However, US dietary consumption data from 2007 to 2010 show that 92% of the population fails to consume the AI for choline. Choline deficiency has a significant impact on our health and well-being. The extent of the deficiency is only lately being recognized. Choline functions in development and maintenance of cognitive function, including development of the memory center in infants and toddlers. It helps prevent non-alcoholic fatty liver disease (NAFLD) in adults and contributes to heart health, liver health, sports performance and helps prevent fetal neural tube defects. Key Choline Awareness of choline within the scientific community dates back more than 40 years, with choline eventually declared an essential nutrient in 1998. However, despite knowledge of the nutrient’s role in cognition and other health issues, there has been a paradoxical lack of attention to choline by health professionals and media. Although it’s a nutrient of key importance, choline has been seemingly sidelined for no apparent reason. For example, the 2010 Dietary Guidelines called out choline as a nutrient chronically underconsumed with significant resultant health effects. However, in those same guidelines’ policy recommendations intended to support the population’s health for the next five years, there was no mention of choline. Similarly, choline’s role in pregnant and lactating women has a parallel impact to folate. Yet a national campaign was launched to include folic acid in food fortification with the objective to prevent neural tube defects by adequate consumption of the nutrient, while choline was virtually ignored. Awareness of choline’s health benefits is so low among the professional community that relatively few choline supplements exist (although it is added to some B-complex vitamin formulas). The opportunity exists to promote better health for all ages and life phases—from infants and children, to pregnant/lactating women as well as adult men and women in general. This can be done by promoting the increased consumption of choline, including supplementation. Major trackers of supplement sales have not yet begun to monitor the sales of choline supplements. Only Nielsen/ SPINS reported on choline sales in 2012, and then only in combination with inositol. Sales in combined natural/ mass channels reached $428,000— far from the multimillion-dollar levels of other nutrients. Role in Cognition Choline is an essential nutrient, functionally complementary to B vitamins and omega-3 fatty acids. Choline functions as a critical component of the building blocks of the nervous system, including the neurotransmitters that form the mechanistic basis for memory. Choline is part of the messaging system of the brain as well, performing directly and indirectly in brain activities and supporting cognitive development for the fetus and infant. Choline also is a precursor to acetylcholine, supplying the raw materials for the enzyme that generates the neurotransmitter, and is a part of phosphatidylcholine, a structural component of the phospholipid membrane of all cells, including glial and neuronal cells. It is also a precursor to sphingomyelin, a lipid compound important to the integrity of neurons and in the metabolism of molecules which function in intracellular signaling. Choline supports the communication between neurons in the brain and promotes the improved ability of neurotransmitters for signaling within the brain, including up- or down-regulating the activity of the enzymes that synthesize acetylcholine. In this way, healthy plasma levels of choline support brain messaging. The availability of choline at different stages of human development and aging appears to be significant in improving the density and branching of dendrites, resulting in more contact points for neurotransmission. Choline’s availability affects the strength of neuronal response to stimulation in the parts of the brain responsible for memory, including the hippocampus. The level of choline in the brain is directly affected by its levels in plasma, supported through dietary intake and supplementation. Oral intake of choline affects both blood levels of choline and acetylcholine. Cognitive decline in aging is due in part to oxidative events that result in occlusive damage to tissues and organs. These oxidative events may be related to high levels of homocysteine, which in turn are directly and inversely associated with choline intake. In fact, homocysteine could work as a biomarker, byproduct, risk factor or active agent of biochemical change. However, it is widely thought to also have an opposing role in cognitive decline in normal aging, and might degrade parts of the brain. Failure in cognitive functions that occur in aging include: reduced synthesis of the neurotransmitter acetylcholine, breakdown or insufficient repair of neurons, loss of myelin, diminishment of dendrite branching, and cell death in the hippocampus. If one or more of these factors affecting memory loss can be modulated by choline intake, then it’s possible that choline intake in normal aging might also restore cognitive function in the otherwise healthy aging individual. Maintaining mental sharpness and memory as we age is a primary consumer concern worldwide. The market reflects this, with sales of brain health supplements racking up $660 million in 2013. This is an increase of 5.4% over 2012. With the first of the 77 million Baby Boomers turning 70 this year, and 81 million Gen-Xers rolling into middle age, this concern can only increase. Liver and Heart Health There is strong evidence that adequate choline supports normal liver functions and, as previously noted, helps to prevent NAFLD and fatty liver. NAFLD affects one-third of US adults; one-half of obese men; and 11% of adolescents. One in 10 Americans have liver disease in general. It is such a health concern that sales of liver “detox” supplements topped $111 million in 2012, almost double the sales for the previous year. NAFLD is known to occur either as a result of choline deficiency or alcohol consumption. Choline functions in liver health through a variety of mechanisms. Its role as part of the phospholipid phosphatidylcholine is critical, as it is a primary structural component of the phospholipid membrane of all cells. This phospholipid also is needed for the construction of very low density lipoproteins (VLDL) , which function in fat transport through the cardiovascular system. In animal studies, subjects fed diets deficient in choline and methionine develop fatty liver. They also develop liver fibrosis and liver cancer. The effect of choline on preventing fatty liver has been evident for some time. Research published as far back as 1958 demonstrated the positive effects of choline on liver health. Choline impacts heart health through a variety of mechanisms. First, it lowers homocysteine levels. Homocysteine triggers oxidative stress and damage, with an increase in LDL cholesterol, all leading to formation of plaque on arterial walls. Choline also works to support a strong heart muscle with regular contractions, leading to a controlled and lower heart rate with less stress to the heart over time. The aforementioned neurotransmitter acetylcholine is used by nerve cells that control the heart, muscles and lungs. Specifically, it supports communication between nerves and the heart muscle. Acetylcholine is released at the junction between nerve and muscle cells, called the motor end-plate. This release signals calcium ions to begin muscle contraction. Heart health is a key consumer concern. Heart supplement sales were estimated at $2.4 billion in 2013, up 6%. One in five adults say atherosclerosis is an important health concern; and stroke is a fast- emerging concern for those under age 65. Pregnancy and Lactation In pregnancy, mechanisms exist to protect the supply of choline to the developing fetus. Choline availability to a fetus appears to have an enduring significance in that individual through to an advanced age. Choline plays a critical role in brain development in the fetus and in infants, especially in the development of the hippocampus and basal forebrain, known to regulate memory. Choline also acts like folate in preventing neural tube defects in fetal development. Choline’s function is similar to the effects of the omega-3 fatty acid docosahexaenoic acid (DHA). Both choline and DHA promote the extent of dendrite branching in hippocampal neurons, supporting the messaging capacity of the brain. Benefits of pre- and postnatal choline availability are seen in behavioral studies in animals. Performance enhancement in offspring provided sufficient choline early in life is most evident in better execution of complex memory-related tasks, particularly those involving visiospatial tasks, serial learning and memory. Folate, choline, and betaine serve as hydroxymethyl group donors, and all are important in the prevention of neural tube defects (NTD) and other birth defects, including anencephaly—in which the brain fails to develop in a fetus—or spina bifida. These defects occur early in pregnancy, between the 21st and 27th days after conception—a period when many women do not realize that they are pregnant. There is clear evidence of suboptimal intakes of choline by most individuals, especially pregnant and lactating women. Human studies show that women in the highest quartile of choline intakes had a 72% lower risk of NTD-affected pregnancy and those with lowest levels of serum choline had 2.4-fold greater risk (Shaw et al, 2009). Choline is emerging as one of the most important nutrients for food fortification and supplementation. Choline can be easily added to prepared foods, beverages and dietary supplements. It can be added as a water-soluble salt in the form of choline chloride (CC) or choline bitartrate (CBT). It is recognized as a GRAS ingredient (21 CFR 182.8250 &8252). Choline can easily be added to liquids and beverages, either in ready-to-drink or powdered formats. It’s also available in forms suitable for inclusion in cereals, dressings, seasonings, fruit and vegetable purees and baked goods. It is stable in high temperature processing and will remain stable for more than 36 months in storage. Catherine Adams Hutt Ph.D., R.D., C.F.S., is a registered dietitian and certified food scientist, as well as a nutrition, regulatory and QA expert. She’s president of RdR Solutions Consulting and has held senior global positions for McDonald’s Corp., HJ Heinz Co., Campbell Soup Co., Coors Brewing Co. And YUM! Brands Inc. Catherine can be reached at firstname.lastname@example.org. Choline at the Gym: Sports Nutrition THERE IS UNPRECEDENTED demand for high-performance products and a dramatic increase in the number of Americans who think exercise is important. Serious numbers of adults—dubbed the “New Actives” in the sports world—are becoming more physically active and have caused the lucrative sports nutrition segment to move mainstream. Just consider that… … six in 10 adults are giving a lot more thought to the amount of physical activity they get, with 55% considering themselves moderately active and 11% being vigorously active (IFIC Food & Health Survey, 2014). … nearly all those who describe themselves as active say they are active three to five days a week. In 2013, 48% of adults increased the amount of time or number of days a week that they were active (IFIC, 2014). … today, 96 million people are exercise walkers, 56 million exercise with equipment, 39 million are aerobic exercisers, 36 million work out at a club, and 66 million jog. Approximately 50% engage in some sort of strength training (National Sporting Goods Assn., 2014). … those aged 50+ are the fastest-growing segment of exercisers. Teen workouts also are increasing. (HealthFocus, 2013). Why Choline is a Good Choice The sports and fitness performance category indexes higher as a health concern than most major condition-specific categories, including digestive health, joint/bone health, and immunity. Muscle strength is an important consideration for “New Actives,” young and older consumers alike. Choline supplements make sense for athletes because US consumer intake of foods providing the richest sources of choline– liver, eggs and a variety of meats—has decreased in recent years. In fact, 90% of the U.S. population does not consume adequate amounts of choline. Sports nutrition is poised to outgrow all other major consumer health categories through 2018, according to Euromonitor International. Choline, an essential nutrient that is important to overall health and optimized physical performance, benefits athletes in several ways. It can enhance muscle performance during exercise, and it improves stamina. Also, because choline supports communication with muscle fibers and promotes muscle recovery following repetitive motion, it improves overall training output. For active individuals such as athletes, choline promotes and regulates proper metabolism for increased energy and endurance. It controls the deposition of fat and allows the body to store it efficiently, or tap it as an energy source. Those over age 50 are the fastest-growing segment of exercisers, although teen workouts are increasing, too. For adults and teens alike, choline supports messaging between the brain and muscle fibers for more efficient and precise movements as well as improved coordination. Choline aids in maintaining the nervous system, which delays the onset of fatigue during strenuous activity. When athletes are deficient in choline – and the sources of choline are exhausted in the body – the body will take choline away from other key systems and organs. That is why adequate choline intake is important to health and optimized physical performance. Choline also serves to protect the body’s natural pool of nitric oxide. Nitric oxide expands arterial walls, increasing oxygen- rich blood flow to exercising muscles. However, nitric oxide is a molecule that lasts for only a second in the bloodstream and then has to be replaced. Choline supports optimal nitric oxide functions in the body, which is good for all athletes, especially body builders. For more information: The Choline Information Council www.cholinecouncil.com
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